A leaked memo circulating among South African researchers that is addressed to grant management staff of the US government's National Institutes of Health (NIH), dated March 25 and of which Bhekisisa has seen a copy, instructs officers to hold "all [research] awards to entities located in South Africa".
Although NIH didn't confirm the existence of the memo, in response to Bhekisisa 's questions late on Thursday night, it also didn't deny it.
Several local and international researchers and advocates, with close connections to the NIH, that Bhekisisa has spoken to, believe the memo to be coming from political appointees in the US department of health and human services who are instructing the NIH what to do, similar to what happened to United Agency for International Aid (USAID) employees being instructed by the US department of state, when they had to end HIV grants in February .
The NIH is hosted within the department of health and human services .
The confidential memo, labelled "draft", states that it replaces a previous document sent on February 13 and explains which research grants to terminate.
The memo states that "additional guidance on awards to foreign entities is forthcoming" but "at this time" NIH Institutes and Centres should "hold all awards to entities located in South Africa" or countries considered of "particular concern" by the US state department, "state sponsors of terrorism", "office of foreign assets control sanctions list" or "final rule restricting transfer of personal US data to countries of concern".
South Africa, along with China, is listed as a "country of concern".
Some experts estimate that as much as 70% of South Africa's medical research, or up to $400-million (about R7.2-billion) when both direct and subgrants are considered for the past financial year, is funded through the NIH, which is made up of 27 institutes and centres that each focus on a specific area of research.
The NIH finances as much as 88% of biomedical research worldwide, according to the World RePORT , which tracks research funding.
A leading researcher, who prefers not to be named, told Bhekisisa : "It is extremely troubling that such a document even exists, whether it is fully implemented or not. It demonstrates an urgent need for the SA government to work with researchers to find an alternative solution to the situation."
The weekend's cancellation letters
Cancellation letters, which end hundreds of millions of rands of NIH research grants to South African universities and nonprofits attached to them, especially in the field of HIV and TB, started to roll in over the past weekend .
One such project is the University of the Witwatersrand's Wits Health Consortium , the unit through which the institution runs its clinical trials and donor-funded projects. It received cancellation letters for all components of a grant of $2.5-million (R45.5-million), which is due to end in November 2027. The grant was awarded through the NIH's National Institute of Allergy and Infectious Diseases (NIAID).
Local researchers and international advocates say they expect another batch of terminations for NIH grants in South Africa on Friday evening, March 28; the terminations of US government grants seem to be released in batches, each Friday, as has been happening over the past few weeks.
The cancellation letters instruct researchers to end their projects as they're based on "artificial and non-scientific categories", "provide low returns on investment", and "ultimately do not enhance health, lengthen life, or reduce illness".
"Every day, every minute, you're checking your grant on the NIH website, to see what might have happened. It makes it hard for scientists to roll out new study protocols, because there's a sense of, 'should we, shouldn't we'," says Linda-Gail Bekker from the Desmond Tutu Foundation based at the University of Cape Town.
Bekker was the chief investigator for a groundbreaking study , released in 2024, in which a twice-yearly anti-HIV injection was shown to be 100% effective in preventing young women from getting infected with the virus.
NIH response to Bhekisisa's questions
On Thursday, Bhekisisa asked the media office of the NIH to confirm the latest memo's veracity, and if it's indeed genuine, to explain what the timeline is for cutting SA's grants and why SA has been listed as a country of concern.
Instead of confirming or denying the memo, the deputy director for public affairs, Amanda Fine, instructed Bhekisisa to submit a Freedom of Information Act (Foia) request, which is similar to a Promotion of Access to Information (Paia) request in South Africa.
In the US, a Foia request is made to give someone "access to records of the executive branch of the United States government " .
But when we clicked on the link Fine sent, it referred us to a notice that says: "You are about to access a United States government computer system. This information is provided for US government-used authorised only. Unauthorised use of this system may result in disciplinary action, as well as civil and criminal penalties."
The notice continued: "By using this information system, you understand and consent to the following: You have no reasonable expectation of privacy of any communication or data transiting or stored on this information system. At any time, and for any lawful government purpose, the government may monitor, intercept and search and seize any communication or data transiting or stored on this transformation system."
Trump's choice for NIH director confirmed
On the same day that the memo was dated, the US Senate confirmed Jayanta Bhattacharya, a Stanford University doctor and economist who, The Washington Post reports, "rose to prominence as a vocal critic of the country's handling of the COVID-19 pandemic", as the new NIH director. Bhattacharya is a co-author of the Great Barrington Declaration, which opposed mask wearing and lockdowns during COVID.
The Post reports that during Bhattacharya's confirmation hearing, he said the NIH was "at a crossroads," saying the agency "oversaw a culture of cover-up, obfuscation and lack of tolerance for ideas that differed from theirs."
Although the termination letters of South African projects that Bhekisisa has seen say they can appeal the NIH's decision to end their grants, the notes simultaneously state "no corrective action [to the terminated programmes] is possible" and the "premise of this award is incompatible with agency priorities, and no modification of the project could align the project with agency priorities".
The latest memo gives grant staff five scenarios to respond to, along with text to use when doing so:
1. Projects of which "the sole purpose" relates to an area that the NIH no longer "prioritises";
2. Programmes that partially support the NIH's new goals, and "may still be viable", if adjusted; 3. Grants that don't "support any DEI activities" and can therefore continue;
4. "Departmental authority terminations", which are projects on a list from the NIH director that he would like to have terminated; and
5. "Awards to entities in certain foreign countries".
South Africa is mentioned under categories two (as an example of a country where research projects can't have sites) and five.
Does SA get more flack than other countries?
In early February, President Donald Trump issued an executive order to halt foreign aid to South Africa, accusing the country of oppressing Afrikaners and "unjust and immoral practices that harm our nation [the US]" .
Although research grants aren't foreign aid, and cancellation letters have, so far, not referred to the executive order, President Trump does seem to single South Africa out, says Mitchell Warren, the executive director of the international health advocacy organisation, Avac.
"Although the issues related to research cuts are a global challenge, South Africa does bear the brunt of so much of this new US presidential administration's ire," Warren says. "It is very clear that the president is using budgets and terminations of previously agreed to programmes to redefine agendas, and in this case ones that defy science and are clearly political and ideological."
Research grants are getting cut around the world
While only South Africa and China are specifically named in the NIH memo, research grants in Brazil and at least 300 US university projects in the United States itself, have also been ended.
On Friday, a 24-year old programme, the Adolescent Medicine Trials Network for HIV Interventions , which worked to prevent HIV in teens and young adults, received a termination letter related to an $18-million grant.
On Monday ProPublica reported their journalists had seen internal NIH records stating that the grants funding research on the health effects of climate change will be terminated. This lines up with the latest NIH memo Bhekisisa has seen, which states climate is no longer a priority.
And, earlier this week, Science magazine reported that they had confirmation from the NIH that it would end all COVID-19 research because it "will no longer waste billions of taxpayer dollars responding to a non-existent pandemic that Americans moved on from years ago."
What happens when grants are abruptly ended?
South African universities will face devastating consequences if all NIH grants are cut, says Bekker. "As a result of research grants, universities receive administrative support through indirect costs, and our clinical trial sites build the next generation of HIV and TB researchers, as almost all our grants include positions for PhD and postdoc students," she says.
The infrastructure of some of the research sites that Bekker runs for HIV research, could, for instance, be used to test the Johnson & Johnson COVID jab.
"It takes decades to build this infrastructure, it's not something that can be rebuilt overnight," she says.
At the Conference on Retroviruses and Opportunistic Infections in March, where much of the latest HIV research is released, the internationally recognised epidemiologist and director of the Duke Global Health Institute, Chris Beyrer, told Bhekisisa : "One of the reasons South Africa has done so well with HIV research is because of the extraordinary depth of scientific talent. [Because of the HIV and TB research grants and USAID cuts in February] talented people may be worried about going into this field, and the talent and human resource is fundamental."
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Already then, Beyrer said, "we're now worried about our international partnerships for collaborative research with countries like South Africa, and also China".
Moreover, Bekker says, HIV and TB infections, as well as deaths, will increase. "Viruses and bacteria constantly change. That's why we need to consistently develop new medicines. We need to stay ahead of the pathogens. But if the funds are lacking, we have less ability to do so."
A Lancet editorial published on March 20 cautions against "the emergence of widespread drug resistance", "leading to a dramatic increase in infectious disease burden worldwide".
Meanwhile, on Wednesday, The New York Times reported , the Trump administration will end its financial support for Gavi , which helps to vaccinate more than half the world's children against some of the deadliest diseases, and it will also cut funds for malaria. The Times got hold of a spreadsheet, sent to the US Congress, which details such cuts.
Mark Suzman, the CEO of the Gates Foundation, which has given $4.1-million to Gavi, was disturbed: "If true, and if Congress allows this to happen, the impacts will be devastating, including the possibility of hundreds of thousands, if not millions, of preventable deaths, especially among mothers and children. We are going to do everything possible to convince the Administration and the Congress to reverse these actions if true," he said on Wednesday night on LinkedIn .
Warren warns that the speed at which the Trump administration moves with its cuts, and the abrupt manner in which they do this, will only increase uncertainty.
"If these last eight weeks [since Trump's inauguration] are anything to go by, the next three years and 10 months [left of Trump's presidential term] [will be] terrifying.
"We've seen the systematic dismantling of some of the most critical infrastructure in global health, for research, for implementation and for policymaking. I worry that this has only just begun."
The Gates Foundation is mentioned in this article. Bhekisisa receives funding from the Foundation, but is editorially independent.
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
